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WALGREEN CO.
DSH370218 SAINT FRANCIS HOSPITAL SOUTH
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Covered Entity Details
Entity Name
SAINT FRANCIS HOSPITAL SOUTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370218
Entity Address
10501 EAST 91ST STREET SOUTH
TULSA, OK 74133
Medicare Provider Number
370218
Participating Start Date
7/1/2024
Last Recertification Date
8/15/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02361
12802 E 96TH ST NORTH
OWASSO, OK 74055-5371
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/25/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Eric Schick, Senior Vice President - Chief Financial Officer
(918) 494-8430
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2015
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